Laryngeal Electromyography-Guided Injection Laryngoplasty: A Prospective Series.

OBJECTIVE

Laryngeal electromyography (LEMG) is a well-established method for botulinum toxin (Botox) injections and has also been advocated for the treatment of vocal fold paralysis. We hypothesize that LEMG may also help with the therapeutic injection of other substances. We report on 64 subjects and 118 LEMG-guided injection laryngoplasty procedures. Fiber-optic laryngoscopy was performed after injection to assess the validity of this approach.

MATERIAL AND

METHODS

Between 2020 and 2026, 64 subjects were selected for LEMG-guided injections, totaling 118 vocal fold injections. Inclusion criteria were patients in whom standard fiber-optic-guided injections were impractical or not tolerated, those requiring Botox or PRP injections, or those with difficult anatomical landmarks. Sixteen vocal folds received simultaneous Botox injections, with the remaining receiving PRP injections. There were no cases of complete paralysis. The main reasons for choosing LEMG injections included patient anxiety (n=8), aversion to the endoscope (n=24), the absence of a second practitioner (n=12), need for Botox (n=16), or poor anatomical landmarks (n=9). After LEMG injection, all patients underwent fiberscope evaluation to validate the adequacy of the procedure.

RESULTS

Fiber-optic evaluation identified extravasation of PRP or hyaluronic acid (Restylane) in six cases, incorrect lamina propria injection in five cases, and inadequate injection in eight cases. One complication following Restylane injection into the lamina propria required immediate removal. Of 64 patients, 58 (90%) achieved satisfactory augmentation. Injection time was shorter and more comfortable for the patient than with a two-operator approach using indirect, fiber-optic-guided injection laryngoplasty.

CONCLUSION

LEMG-guided injection laryngoplasty can be performed with low morbidity. It is an alternative to fiber-optic-guided injection. Use this method when two-operator injections are unavailable, patient tolerance to fiberscope examination is poor, or LEMG expertise is available. Use temporary substances, as extrusion and inadvertent lamina propria injection are possible complications.

LEVEL OF EVIDENCE: Level IV, retrospective observational study.